Clinical Evaluation and Management of Children with Meningomyelocoele

Author(s): Dinesh Shukla1 , Sanjay Chaube2

BACKGROUND Neural tube defects (NTDs) are one of the most common birth defects affecting the Central Nervous System (CNS) and is often associated with complex birth defects compatible with survival.1 NTD is a general term for a congenital malformation of the central nervous system (CNS) occurring secondary to lack of closure of the neural tube and has a worldwide incidence of 1.0 to 10.0 per 1,000 births. Congenital malformations of spine and spinal cord are collectively termed as spinal dysraphism. It includes a heterogenous group of anomalies resulting from incomplete midline closure of osseous, mesenchymal and nervous tissue.2 Most of these conditions are diagnosed at or soon after birth, but some are diagnosed late in childhood or in adulthood because of absence of clinical manifestations. We wanted to evaluate the causative factors, clinical features, management and postoperative complications of children with meningomyelocoele. METHODS This is a retrospective study and all children having meningomyelocoele born between April 2014 to May 2016 were included in the study. Clinical features, maternal educational status, size and location of the defect, operative details such as time to surgery and its relation to postoperative morbidity and mortality were recorded. RESULTS A total of 36 patients were evaluated in the study period. There were 20 (55.6%) males and 16 (44.4%) females. Most common location of MMC was in lumbar (83.3%) and followed by thoracolumbar (16.7%) regions. None of the mothers received folate supplementation. Hydrocephalus (n = 18), pelvicalyceal ectasia (n = 3), pes equinovarus (n = 7), Chiari II malformation (n = 4)), pelvicalyceal ectasia (n = 3), hip dysplasias (n = 2), accounted for additional anomalies. Short term complications following surgery were bladder dysfunction in 8 patients (22.2%), 7 patients (19.4%) had seizures, 6 patients (16.7%) had bacterial meningitis and 3 patients (8.3%) had severe hydrocephalus and 4 patients (11.1%) had ventriculitis. CONCLUSIONS Operating on patients with meningomyelocoele with in 72 hrs. of birth reduces complications, hospital stay and antibiotic usage.